Fırat University Faculty of Medicine Hospital
Elâzığ, 23100, Turkey (Türkiye)
Location status: Recruiting
Recruiting
NCT Number: NCT07467291
SPSIP Block vs SAP Block for Post-VATS Pain
Comparison of Superior Serratus Posterior Intercostal Plane Block and Serratus Anterior Plane Block for Pain Management Following Video-Assisted Thoracoscopic Surgery: A Randomized Prospective Study
Introduction Video-assisted thoracoscopic surgery (VATS) is associated with lower postoperative pain, shorter hospital stays, and better preservation of pulmonary function compared with conventional thoracotomy, owing to its minimally invasive nature. Although VATS was initially performed using a multi-port technique, it has evolved into a single-port approach, reflecting advances in surgical techniques and equipment. In Uniportal VATS, limiting surgical trauma to a single intercostal space may reduce the risk of chronic postoperative pain by decreasing intercostal nerve damage.
Because inadequate pain control after VATS may predispose patients to developing chronic post-thoracotomy pain syndrome (PTPS), effective postoperative analgesia is critically important. Therefore, regional analgesic techniques are recommended as part of multimodal analgesia. PROSPECT guidelines do not recommend the routine use of thoracic epidural analgesia for VATS, despite its effectiveness, because of its invasiveness; instead, they emphasize peripheral blocks such as paravertebral block and erector spinae plane block.
Although not included among first-line analgesic interventions in PROSPECT guidelines, the serratus anterior plane block (SAPB) is a widely used and well-established technique in thoracic surgery. In addition, the superior serratus posterior intercostal plane block (SPSIPB) is gaining attention in VATS surgery because of its analgesic effect covering the C3-T10 dermatomes.
Although there are studies in the literature comparing SAPB with different regional techniques, there is no randomized controlled trial directly comparing it with SPSIPB. Therefore, this planned study aimed to evaluate whether SPSIPB is noninferior to SAPB for postoperative analgesia and to compare the postoperative analgesic efficacy of the two techniques performed under ultrasound guidance.
Recruiting
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Request InfoKey information
Conditions
Age range
18 year–65 year
Sex eligibility
All sexes
Study type
Interventional
Phase
Not applicable
Primary location
Who can participate
Healthy volunteers accepted: No
Only the study team can determine whether someone qualifies for participation.
Inclusion criteria
- aged 18-65 years,
- with American Society of Anesthesiologists (ASA) physical status classification I-III,
- Body Mass Index (BMI) < 35 kg/m²,
- and who read and signed the informed consent form were included.
Exclusion criteria
- inability to communicate in Turkish, refusal to consent,
- inability to use the numerical pain rating scale (NRS),
- allergy to local anesthetics or study-specific analgesics;
- pregnancy or breastfeeding;
- uncontrolled anxiety or substance dependence;
- history of thoracic surgery,
- trauma,
- neuromuscular or peripheral nerve disorders;
- diabetes mellitus,
- hepatic or renal insufficiency,
- coagulation disorders;
- chronic opioid or steroid use;
- widespread pain;
- anticoagulant therapy;
- infection at the block application site;
- early termination of surgery;
- absence of planned postoperative extubation.
Treatment and study plan
Serratus Anterior Plane Block (SAPB) group
ProcedureThe block was performed with the patient in the lateral decubitus position. Ultrasound-guided SAPB was performed by the same anesthesiologist with over three years of experience in ultrasound-guided regional anesthesia, using a high-frequency linear probe (LOGIQ e Ultrasound, GE HealthCare, United States). The probe was positioned parallel to the mid-axillary line, and the ribs were readily identified as hyperechogenic lines. The fifth rib was identified in the mid-axillary line. Using an in-plane technique, the needle was placed in the myofascial plane between the serratus anterior muscle and the fifth rib, and 20 mL of 0.25% ropivacaine was injected. The needle was then withdrawn until it reached the myofascial plane formed by the serratus anterior and latissimus dorsi muscles, and a hydrodissection technique was used to confirm that the needle was located in the intended myofascial space. After negative aspiration, 10 mL of 0.25% ropivacaine was injected.
Serratus Posterior Superior Intercostal Plane Block
ProcedureThe procedure was performed with the patient in the lateral decubitus position. After a slight lateral displacement of the scapula, the scapular spine was visualized with ultrasound, and the probe was moved medially. After locating the tip of the scapular spine, the probe was placed sagittally at the superior angle of the scapula, and the third rib was visualized. The block needle was advanced craniocaudally and placed between the posterior superior serratus muscle and the third rib. Hydrodissection was performed with an injection of 2 mL of saline to confirm block needle placement. After confirming the block site, 30 mL of 0.25% bupivacaine was injected.
Primary outcomes
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To determine the effectiveness of ultrasound-guided SPSIP block versus SAP block after VATS using postoperative NRS pain scores.
Time frame: NRS scores will be assessed at 1, 6, 12, 18, and 24 hours postoperatively.
The NRS score is based on the patient rating their pain on a scale from 0 to 10. Zero indicates no pain, while 10 indicates the most severe pain possible.
Secondary outcomes
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QoR-15 recovery score
Time frame: up to 48 hours
The QoR-15 (Quality of Recovery-15) scale is a patient-reported outcome questionnaire used to evaluate the quality of postoperative recovery. The QoR-15 consists of 15 items assessing five domains: pain, physical comfort, physical independence, psychological support, and emotional state. The total score ranges from 0 to 150, with higher scores indicating a better quality of recovery.
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time to first rescue analgesia
Time frame: up to 48 hours
the time to first rescue analgesia (tramadol 0.5 mg/kg), defined as the time interval between recovery from anesthesia and the administration of the first analgesic dose (expressed in hours), was recorded.
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The total amount of rescue analgesic consumption
Time frame: up to 24 hours
The total amount of rescue analgesic consumption within the first 24 postoperative hours (mg) was also documented.
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the incidence of block-related complications.
Time frame: up to 48 hours
block-related complications such as hematoma, paralysis, hypotension or other adverse events were recorded.
Study contacts
Contact information is provided by the study sponsor or research team.
Sponsors and collaborators
Lead sponsor
Firat University
Other
Registry information
Official study title
Comparison of Serratus Posterior Superior Intercostal Plane Block and Serratus Anterior Plane Block for Pain Management Following Video-Assisted Thoracoscopic Surgery
Important dates
- Study start
- 2026
- Primary completion
- 2026
- Study completion
- 2026
- First posted
- Mar 12, 2026
- Registry last updated
- Mar 12, 2026
OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.
View the official ClinicalTrials.gov record (opens in a new tab)This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.